Increasing number of Chinese to rely on nursing homes in old age
By Feng Yilei

Taking care of the elderly is part of tradition in China where people mostly prefer to spend their retirement years at home. But data suggests the number of incapacitated seniors over 60 in China exceeded 42 million in 2020, accounting for about 16 percent of the elderly population over 60 years old. As the country's population ages, with fewer young people to care for seniors, the attraction of nursing homes has grown in recent years.

For 70-year-old economist Zhu Ling of Chinese Academy of Social Sciences, China's pension industry is one of the many fields of her academic research. She is also a daughter and a senior. Zhu now visits her 91-year-old father at his nursing home at least twice a week. The choice she made about her father is one that many in this rapidly aging country will have to make in the near future.

"It wasn't that my parents couldn't stay at home. They were just too incapable of living on their own," said Zhu. She explained that she's also well prepared to go to a nursing home someday. But for now, she said she could still take care of herself, and thus have more options.

An article by Zhu titled "Turn to Community Nursing Homes," detailed the reasons behind her decision to settle her parents in a nursing home. It's gone viral and triggered heated discussion online – some are anxious about the elderly care issue, some fear about their incapacitation.

"I suffered from great psychological pressure, and almost got sick when trying to get them into a nursing home," Zhu said, but readers' comments show that most people have tended to agree with her decisions. Likewise, recent surveys also suggest more and more Chinese are changing their old mindset that institution-based elderly care contradicts the country's traditional virtue of filial piety.

Experts say it's an inevitable trend given our longer life spans and fewer children, as well as the division and specialization of labor. 

"Though I still continue working today – giving lectures and speeches about China's development experience worldwide. That's my expertise, not nursing others," Zhu said, noting it was a decision to turn to professionals, not abandoning her parents.

By the end of 2020, China had over 38,000 institutions, meaning elderly Chinese now have diverse options when it comes to choosing a nursing home that fits their specific needs. Taking Beijing as an example, senior citizens can pick from some 400 listed institutes on an app launched by the Ministry of Civil Affairs (MCA), with prices ranging from three-digit figures to five-digit figures in yuan per month. Users can then evaluate their room size, service and payment type, ownership and location.

But finding a satisfying home presents new problems. Zhu said that there weren't many that met all her requirements – namely good facilities, location and medical treatment, and a warm atmosphere, all at a reasonable price. It took her some time to find the best suited one. The nursing home where Zhu's father lives is now fully occupied, with over 100 people waiting in line to move in.

Meanwhile, a considerable number of nursing home beds across the country are left unused. It can be estimated from figures released by MCA last July that the average occupancy rate of nursing homes nationwide is only about 50 percent. Li Xiuli, vice president of Weihua nursing home, which is about 20 kilometers away from Beijing's city center, said their institution, with only a 30-percent occupancy rate, is operating at a loss.

"We're a little bit remote and less known. We haven't operated for a long time and have been affected by the epidemic. We lack commercial promotion. After all, our capital strength is limited. And we haven't gotten government subsidies so far," said the manager.

Li also added that she felt that nursing homes is not a business that will rake in huge profits, as there's lots of investment in housing, equipment, fresh food, a professional long-term care team and more.

For pensioners, however, cost performance also poses a concern. Du Xiufen, who used to pay only 3,000 yuan ($465) living elsewhere but currently lives at Weihua nursing home, said it was uncomfortable and she couldn't stand the food. 

"Now my pension can merely cover my expenses here. But I will not be able to afford it when I become incapable someday," she added.

Pensioner Chen Guosen, on the other hand, finally decided to hire a live-in caretaker for his father, after an unhappy experience with services at the nursing home. Chen said none of the affordable and available nursing homes nearby meet his standards. 

"We will probably have a look around outside Beijing," he said.

Some experts, including Zhu, believed supply and demand are all about finding the right balance, with more market players entering the growing sector and more government and social support in place. 

"The market has responded very quickly. Five years have passed since I got to know this nursing home brand and it has expanded from one to all over Beijing," said Zhu.

When talking about the nursing home where her father lives in, Zhu believes that the market will weed out those with poor management. She also called on both the government and society to take responsibility for supervising these institutions. 

"There should also be regulations about it," the expert said.

The ultimate goal is not to bring all seniors in the country to a nursing home. China has been running a "9073" guideline for a decade. It's estimated that 90 percent of the population stays at home, 7 percent receive help from the community, and only 3 percent are looked after by an institution. The most imperative thing at the moment, according to experts, is to meet the most urgent needs – low-income seniors that are severely incapacitated.

(Cover via CFP)

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